September 2020

September 2020

The Office: Cardiovascular Disease Revisited Part 1

  • Excess Etiologies
    • Blood and Qi Stasis
      • Left Cun Pulse is Blocked (Stage I,II,or III)
      • Symptoms are usually chest tightness, chest pain, shortness of breath, fatigue, anxiety, insomnia, palpitations, overly sensitive and cries easily. The patient can have 1 or all of these symptoms or any combination thereof.
      • General herbal formula:   
        • Xue fu zhu yu tang 80, Dan shen 10, Shui zhi or Di bie chong 10
      • Additions:
        • If the Blocked pulse has a weak quality to it with the other pulse positions thin and weak and one of the symptoms is fatigue then add Huang qi 20 or Dang shen 10 and Huang qi 10.
        • If the Blocked pulse is more severe with chest tightness add San leng 10 and E zhu 10.
        • If Blocked pulse is more severe with chest pain add Pu huang 10 and Wu ling zhi 10
        • If there are palpitations, add Hu po 10 to 20, Ku shen 10 or Zhi gan cao 5 to 10.
        • If anxiety add Hu po 10 to 15
        • If insomnia add Bai zi ren 15
        • If shortness of breath add Ting li zi 15
        • If cries easily add Da zao 10 to 15.
    •  Damp / Phlegm Stasis
      • Left Cun Pulse is too deep, Blocked with a mushy or soggy feeling and there are noticeable signs of Damp retention in the patient
      • Symptoms are those associated with congestive heart disease, overweight, shortness of breath, labored breathing, swollen ankles, possible wheezing; other pulses are too deep indicative of Damp retention and Blood Stasis.
      • General herbal formula:
        • Xue fu zhu yu tang 40, Gua luo xie bai ban xia tang 50, Mao dong qing 10.
      • Additions:
        • If labored breathing with signs of chest fluid or phlegm or wheezing add Ting li zi 10 to 20
        • If swollen ankles (often associated with a weakness in the right side of the heart) add Zhu ling 10, Ze xie 10, Fu ling 10.
        • If insomnia add Wen dan tang 30.
        • If anxiety add Yuan zhi 10 to 20
    •  Excess Heat / Fire
      • Left Cun pulse is convex and pounding at the superficial depth and possibly all other depths
      • Symptoms and signs are hot hands, agitated emotions, insomnia, canker sores, explosive behavior, startles easily, possibly high blood pressure, too hot while sleeping, strong and vivid dreams, too stressed.
      • General herbal formula:
        • Dao chi san 40, Huang lian 10, Lian zi xin 10, Ci shi 10 to 20, Long gu 20.
      • Additions:
        • If high blood pressure add Hu zhang 20, Cha chi huang 20, Sang bai pi 10.
    • Excess Cold
      • Left Cun Pulse is Blocked with a very thin, tight, wiry pulse in the middle of the Blocked pulse.
      • Symptoms and signs are chest pain - either chronic or infrequent; cold hands, purplish or bluish face.
      • General herbal formula:
        • Xue fu zhu yu tang 60, Fu zi 10, Gui zhi 10, Pu huang 10, Wu ling zhi 10.
      • Additions
        • If the patient is quite cold with cold hands can add Gan jiang 5, You gui wan 20.
    • Combinations of all the above.

The Office: Epigastric Pain

  • ACUTE:
    • Food Retention:
      • Pulse;
        • Rt Guan pulse: can be normal or slightly high or low.
        • Right Yang Wei Pulse: too hard or stiff
      • Herbs
        • Bao He Wan 100
    • Stomach Excess Cold:
      • Pulse:
        • Very thin tight pulse in Right Guan
        • Will likely have cold hands, elbows, and abdomen.
      • Herbs:
        • Fu Zi Li Zhong Tang 40
        • Huo Xiang Zheng Qi Tang 60
    • Stomach Damp Heat:
      • Pulse:
        • Right Guan deep /pounding
      • Herbs:
        • If more Dampness than Heat, then use:
          • Gan Lu Xiao Du Dan 70
          • Huang Lian Jie Du Tang 30
        • If more Heat than Dampness, then reverse the above dosages
    • Additions:
      • For abdominal pain, especially flank pain, add:
        • Yan Hu Suo 5 to 15
        • Chuan Lian Zi 5 to 15
      • For stomach pain use
        • Gan Cao 5 to 10
        • Bai Shao 5 to 10
      • For constipation add
        • Da Huang 5 to 15
        • Mang Xiao 5 to 15
  • CHRONIC:
    • Liver Invading Stomach:
      • Pulse:
        • Wiry in both Guans.
      • Herbs: Option 1 or 2
        • Option 1
          • Chai Hu Shu Gan Tang 70
          • Yan Hu Suo 15
          • Chuan Lian Zi 15
        • Option 2:
          • Hu Zhang 15
          • Huang Shui Qie 15
          • Cha Chi Huang 15
          • Xia Ku Cao 15
          • Jia Wei Xiao Yao San 20
          • Huang Lian Jie Du Tang 20
    • Stomach Qi Deficiency with Cold:
      • Pulse:
        • Kleenex pulse in right Guan
        • Usually the patient has cold hands, cold abdomen, and a cool LI 10/11
      • Herbs:
        • Fu Zi Li Zhong Wan 70
        • Huang Qi Jian Zhong Tang 30
    • Stomach Qi Deficiency with Stagnation:
      • Pulse:
        • Right Guan is slightly weak
        • Right Yang Wei pulse is thin and tight. Right guan is wiry
      • Herbs:
        • Xiang Sha Liu Jun Zi Tang 100
    • Stomach Dampness
      • Pulse:
        • Right Guan deep and soggy
      • Herbs:
        • Xiang Sha Ping Wei San 100
    • Stomach Yin Deficiency with Fire:
      • Pulse:
        • Right Guan is thin and above the middle depth
        • Other pulse positions are Yin Deficient also (i.e. higher than they should be and thin)
      • Signs and Symptoms:
        • Signs of Yin Deficiency
        • dry mouth
        • other signs of dryness
        • possible burning sensation in epigastrium
      • Herbs:
        • Mai Men Dong 15
        • Shi Hu 15
        • Sha Shen 15
        • Zhi Zi 10
        • Bai Shao 10
        • Chuan Lian Zi 10
        • Zhi Shi 10
        • Yan Hu Suo 10
        • Gan Cao 5
    • Blood Stagnation in Stomach with Dampness:
      • Pulse:
        • Right Guan is deep and blocked
      • Herbs:
        • Xiang Sha Ping Wei San 35
        • Dan Shen 15
        • Dang Gui 10
        • Yan Hu Suo 10
        • Chi Shao 10
        • Ru Xiang 3
        • Mo Yao 3
        • Bai Shao 15
    • Stomach Excess Heat
      • Pulse:
        • Right Guan is strong and pounding possibly at all 3 depths
      • Herbs:
        • Huang Lian Jie Du Tang 30
        • Zhu Ye Shi Gao Tang 30
        • Yu Nu Jian 20
        • He Zi 5
        • Wu Bei Zi 5
        • Tian Hua Fen 5
        • Bai Wei 5
      • If there is excess stomach acid with a Proximal Right of Left Styloid Pulse, then add:
        • Wa Leng Zi 10
        • Hai Piao Xiao 10
      • If there is not enough Stomach acid add:
        • Wu Mei 4
        • Shan Zha 10 to 15
      • If there is pain add:
        • Yan Hu Suo 10
        • Chuan Lian Zi 10
      • If there is bleeding add:
        • Ce Bai Ye 10 to 15
        • San Qi 10 to 15
      • If there is constipation:
        • Dry stool:
          • Ma Zi Ren Wan 25
        • Wet stool:
          • Da Huang 5-10
          • Mang Xiao 5-10
      • If belching:
        • Ban Xia 10
        • Sha Ren 5

The Office: When to Use Qi Tonics

  • In most cases, patients have an excess and deficiency problem
  • Common excess problems
    • Retained heat
    • Retained Dampness
    • Blood stasis
    • Phlegm
  • The most common deficiency problem is qi & blood deficiency in multiple organs
  • Both problems need to be treated, but you can’t always treat both at the same time.
    • If the pulse is strong or blocked, you cannot give tonics yet.
    • Once you treat the excess problem, the weak pulse will reveal itself
      • Now you can add tonics
  • If you add tonics and the excess problem gets worse
    • You used too much tonic herbs
      • Use 5-10g only and try again
      • Or take out tonics entirely and treat the excess problem only
  • Herbal combos
    • Weak Left & Right Cun
      • Fang Ji Huang Qi Tang
      • Sheng Mai San
        • Best for yin deficiency with qi & blood deficiency
      • Huang Qi by itself
    • All weak pulses
      • Combo one
        • Huang Qi - 33%
        • Ren Shen – 33%
        • Dong Chong Xia Cao – 33%
      • Combo two
        • Huang Qi – 33%
        • Ren Shen – 33%
        • Lu Rong - 33%
      • Under 50 in age
        • Huang Qi only is often enough
      • Over 50 in age
        • Can use Ren Shen more
        • If the patient gets symptoms from Ren Shen, use Dang Shen
  • Bu Zhong Yi Qi Tang tends to produce headaches
    • Better to avoid in most cases
    • Most people do better with Huang Qi only
  • Heart case study
    • Once a heart pulse is mostly unblocked, using blood movers alone often fails to fix the problem
      • The heart-pumping action is weak leading to dysfunction
    • Need to use mostly tonics to make further progress
    • Need to ensure the liver does not become a problem and can handle a stronger heart.
    • Add to Formula
      • Tonic Herbs - 30
      • Liver herbs
        • Jia Wei Xiao Yao San
        • Si Ni San
        • Chai Hu Qing Gan Tang

The Office: The Difference Between Treating Kidney Yin & Yang

  • Pulses
    • Left Chi pulse too high and thin
      • Indicates kidney yin deficiency
    • Left Chi deep and thin, and the patient has cold hands
      • Kidney yang deficiency
    • Left Guan too high and thin
      • Liver yin deficiency
  • Clinically kidney yin deficiency requires larger doses of herbs than kidney yang deficiency
    • For tonifying kidney yin, you need to stack up on yin tonics
      • 80% of the formula will focus tonifying yin
      • Zuo Gui Wan is not enough, add
        • Mai Men Dong
        • Sheng Di Huang
        • Nu Zhen Zhi
    • For tonifying kidney yang
      • 20% of the formula will usually be enough.
  • Example case study - yin deficiency
    • Symptoms
      • Fatigue
      • Insomnia
    • Pulses
      • Weak heart pulse
      • Left Chi too high and thin
      • Left Guan high and thin
    • Strategy
      • Tonify heart
      • Tonify Liver Yin
      • Tonify Kidney Yin
    • Formula
      • Tian Wan Bu Xin Dan OR Ren Shen & Huang Qi
      • Yi Guan Jian
        • Can sub Shu Di Huang instead of Sheng Di Huang if the patient is not hot.
      • Can add in Nu Zhen Zhi
  • Example Case Study - Yang deficiency
    • Signs & symptoms
      • Patient tired
      • Fatty liver
      • Weak heart function with congestive fluid
    • Pulses
      • Deep Left Guan pulse
      • Deep & “Muddy” Left Cun pulse
      • Left Chi pulse is deep and thin
    • Strategy
      • Move blood & drain fluid in the heart
      • Tonify heart function
      • Clear liver heat & damp, move liver blood
      • Tonify kidney yang
    • Formula
      • Xue Fu Zhu Yu Tang - 20
      • Ting Li Zi - 10
      • Mao Dong Qing - 10
      • Ge Xia Zhu Yu Tang - 10
      • Liver Detox – 10
      • Huang Qi – 10
      • Kidney Yang Herbs - 20
        • Tonify Yang Combo
          • Rou Gui -33%
          • Fu Zi – 33%
          • Gan Jiang – 33%
        • Or use You Gui Wan – 100%